Of all the countries surveyed in a recent poll, Americans were the least likely to report relative satisfaction with their health care system -- and the most likely to call for a fundamental change. Here are ten major ways our system is failing us.

Earlier this week, Rudy Giuliani released a radio ad directly engaging the health care debate. "I had prostate cancer five, six years ago," begins the ad. "My chance of surviving prostate cancer, and thank God I was cured of it, in the United States? Eighty-two percent. My chance of surviving prostate cancer in England? Only 44 percent under socialized medicine." Unsurprisingly, Giuliani's statistics are a straight lie resulting from a basic mathematical error. The Annenberg Fact Check Project wrote, "We tracked down the source of that number, which turns out to be the result of bad math by a Giuliani campaign adviser, who admits to us that his figure isn't 'technically' a survival rate at all. Furthermore, the co-author of the study on which Giuliani's man based his calculations tells us his work is being misused, and that the 44 percent figure is both wrong and 'misleading.'" The Giuliani campaign, demonstrating their traditional fidelity to truth and accuracy, have said they will continue using the statistic.

But the basic question Giuliani poses should be central to the presidential campaign: How good is American health care? The developed world is full of alternative models, fully functioning structures that can be viewed as little experiments, the outcomes of which should inform our policies. If our system outperforms its competitors, than we should amplify what sets us apart and pushes us ahead. If we under-perform, we should take a hard look at whether our model really is superior. And luckily, we have the data.

Indeed, we have brand new data. The Commonwealth Fund just released a broad survey collecting health care attitudes and experiences from patients in Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States. Here are summaries of some of the findings:

1. We spend the most. We spend more than any other country in the world. In 2005, our per capita -- so, per person -- spending was $6,697. The next highest in the study was Canada, at $3,326. And remember -- that's "mean" spending, so it's the amount we spend divided by our population. But unlike in Canada, about 16 percent of our population doesn't have insurance, and so often can't use the system. These facts should set the stage for all numbers that come after: Every time you see a data point in which were dead last, or not leading the pack, remember that we spend twice as much as any of our competitors.

2. We don't pay doctors according to the quality of their care. One of the first questions is "percent of primary care practices with financial incentives for quality" -- in other words, how many doctors are paid, in part, according to the quality of the care they deliver. In the United Kingdom, the number is 95 percent. In Australia, it's 72 percent. The U.S. scores lower than anyone else, at 30 percent. Similarly, electronic medical records -- which both increase the quality of care and lower its cost -- have 89 percent penetration in the U.K., 79 percent in Australia, 98 percent in the Netherlands, and 28 percent in America. On both these metrics, we perform miserably.

3. Our wait times are low because many of us aren't getting care at all. It's true, Americans do have short waits for non-elective surgeries. Only 4 percent of us wait more than six months. That's more than in Germany and the Netherlands, but considerably less than the Canadians (14 percent) or the Britons (15 percent). But our high performance on the waiting times only account for individuals who get the care they need. Our advantage dissipates when you see the next question, which asks how many patients skip care due to cost. And here, America is far worse than anywhere else. In just the past year, a full 25 percent of us didn't visit the doctor when sick because we couldn't afford it. Twenty-three percent skipped a test, treatment, or follow-up recommended by a doctor. Another 23 percent didn't fill a prescription. No other country is even close to this sort of income-based rationing. In Canada, only 4 percent skipped a doctor's visit, and only 5 percent skipped care. In the U.K., those numbers are 2 percent and 3 percent. Few of our countrymen are waiting for the care they need, that much is true. But that doesn't mean they're getting it quickly. Rather, about a quarter of us aren't getting it at all.

Indeed, 19 percent of Americans were unable, or had serious problems, paying medical bills in the last year. Comparatively, no other country was even in the double digits. This is part of why we perform well on the waiting-times metric. In other countries, the disadvantaged wait longer for their care, and so show up in the data tracking wait times. In our country, they disappear from that measure, because they never get the care at all. You don't wait for what you're not receiving. So their wait times show up as "zero," when they should really be something akin to infinite. And would you prefer to wait four months for your surgery, or never get it at all?

4. Most of us don't have a regular physician. One might expect, given what we pay, that our care would at least be more central and convenient. But it's not so. Of everyone surveyed, Americans were the least likely to report a doctor or general practitioner they routinely saw. As a result. Americans are the most likely to say their doctor doesn't know important information about their medical history, which has obvious implications for care quality, medical errors, etc.

5. Our care isn't particularly convenient. Nor is medical service more convenient for Americans to access. On such questions as whether your doctor has early morning hours, evening availability, or weekend slots, we're not trailing the pack, but we're not in the lead, either. On evening hours, for instance, we lag behind Australia, Canada, Germany, and New Zealand. On same dayhttp://www.prospect.org/cs/articles?article=ten_reasons...

and on into my 30's, my GP had evening hours 2 days a week and even had office hours on Sat from 8AM to Noon. Of course he also made house calls!!!!!

This GP was my Dr. from when I was 14 years old and he was a new Dr. He delivered both my boys, and also took care of all their medical needs. That was a time when very few people saw the need for "specialists"!

HC Insurance was fully paid by your employer. There was no coverage for office visits, BUT an office visit cost $5.00. There was no prescription coverage, but a prescription was considered expensive if it cost $10.00! If you went to the hospital, all you had to do when you checked out was sign the release form...there were no additional charges except for telephone calls if you made any, and there was NO CO-PAY bill sent to you later either!!!!

but he is one in a million.I am against the computerized medical records for family practice offices as is my hubby. So many of his patients tell him their innermost personal problems and he doesn't think that info should be accessible to anyone but him. It is a confidentiality thing.

I've lived in Pgh. Pa., and Atlanta, Ga. Both have interconnected data systems so no matter what Dr. you go to or what hospital you go to, a "new" physician can access your history. That actually wors out pretty well if you end up in an ER and they don't have to rerun recent tests, or at least already know what problems you have had and where to begin to look to resolve your current problem.

but then you are doing everything twice for twice as much work and I don't know how they are going to mandate it,ie will they want everything computerized?...It is what he plans on doing if it becomes mandatory..use a seperate file. He is not very computer literate so he is not too confident in using them in his practice. The younger docs probably will take to it with ease. His employees do do billing via internet up front.

8. Medicare for all would be the best thing to happen to health care in this country.

While I am a beneficiary of Medicare and love it as it stands, let's be honest and say that financially it is a worst case scenario. It's a case of insuring those that need health care the most and the most often and most expensive. In the industry it's called Adverse Selection and no private company would allow it. But that's exactly why it was initiated in the first place. Under the current system premiums must keep rising and payments to providers decreasing. Of course, we must increase profits for the Medicare supplement insurance industry, right?

Medicare for all would eliminate those problems. You can't have Adverse Selection if your pool includes EVERYBODY. If you insure both the old and the young they balance each other out so you get lower premiums and larger payments to the health care providers. Everyone benefits except the insurance companies (oh, gosh. Those poor babies!).

And that's just what will eventually happen here. Although eventually can be an awful long time. Remember what Winston Churchill said? Something like "You can always trust the Americans to do the right thing. After they've tried everything else."

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